In previous blogs I have written about the first four of Wolf Wolfensburger's broad strategies for giving a "favorable cost/yield ratio" in our field of endeavour (assisting people with intellectual and developmental disabilities). I continue here.
Wolf's fifth recommendation (of a total of 12) is to cut inequitably allocated services in favour of ensuring this goes to those with "similar needs" who get "little or nothing". Wolf may slightly overstate that "Often, it is handicapped people with a lot of powerful advocate figures behind them who get the palaces while their abandoned peers get the hovels" (p. 155), but he is not far off the mark in concept. He goes farther, however, than merely talking about evening the playing field: he talks about eliminating "luxuries" such as renting or owning a whole house; governments "shelling out astronomic sums in order to get the last few residents out of institutions" (p. 155), which "sits poorly with families who had taken care of an impaired person at home, and who were told that they had to do "more with less", while people who were about equally impaired got huge subsidies for community placements" (p. 155). My comments on this is that experience shows that it is sometimes the case that these cuts are made to the "extravagances" of inequitable funding, but it is much more rare to see the "freed-up" funds used for the more poorly (or non-) funded situations. If funders would honour such equalizing there would be, in my opinion, a lot more of it.
Wolf's sixth proposal has to do with the phenomenon that there are examples of services with more and less desirable alternatives. The ability to re-institute a less preferred, but still viable alternative, rather than cut all services leaving nothing in its place, would be preferable. He goes on to talk about a boy with partial vision being assigned two personal aides so that he could be maintained in a regular class. Wolf asks if every child assigned an aide really needs one, and could they not be shared, and "Are there never any suboptimal but still viable alternatives?" Wolf suggests that "Soon, personal aides might outnumber the students in a class". (p. 156). Here Wolf suggests that large classes are better than none at all; segregated [services] are better than none at all; sheltered workshops are better than having no day activities at all; and group homes are better than having institutions revived. Wolf states that "even segregated services can be normalized, normalizing, and social-role-valorizing in many ways". (p. 156)
Wolf points out that "the less preferred alternative may be both less luxurious and more equitable. For instance, there is something grotesque about schools not being able to supply soap and toilet paper, while impaired pupils show up with entourages of multiple attendants, service animals, and animal handlers". (p. 156). Going further still, he decries that impaired people have been enabled to choose the most expensive of several service or living options, and suggests there is nothing wrong with having family and friends bolster and upgrade services (with private funds, of course).
Seventh of 12 suggestions is vintage Wolf, giving high priority to volunteered and "extra-structural" services, services that are not part of the "system" of formal supports and organizations, whether individual or communal. Family, friends, citizen advocates, circles of support are some examples of these. Although some volunteered help is mediated by formal support organizations and by paid workers, such as Citizen Advocacy and Special Olympics organizations who pay staff to organize and lead the volunteer (unpaid) force, and as such fall in between the system and "extra-structural" services. Wolf chronicles the impacts of volunteers and credits them with, among other things, "prying intellectually disabled people out of the service system altogether, and saving many lives", and remarks about volunteers, that "even after their initial volunteer engagement ends, they are often recruitable again later" (p. 156).
After making these remarks, Wolf observes, again accurately according to my experience, that "paid staff supporting volunteers are often the first to be cut. This then makes people angry who want to volunteer but are not well handled. It may alienate them forever from volunteering (Kadlec, 2009)" (p. 156). He goes on to emphasize the importance of supporting these "extra-structural" services and volunteers "as being the only thing that in many instances will be protective of at least some impaired persons when the structures abandon them and/or when societal order collapses, as it did in New Orleans in 2005" (p. 157).
The eighth recommendation made by Wolfensburger is to hold onto at least a modest training and staff development budget, again observing that in his experience these are most often among the first to be cut. He cautions that cutting staff development budgets over too long a term produces "more incompetent staff than one would otherwise", who then become the base level of employee in the organization, so that future new employees get a very low standard of competence as they enter the organization, and lack good role models, mentors and teachers.
Ninth of his recommendations brings out more of Wolf's passion than the others - he says "we should fight to the bitter end" (p. 157) to preserve services which prevent the escalation of services to higher and higher levels of support, and therefore, higher expenditures. He cites as an example home help services which maintain people in their own homes rather than see them escalate to nursing home. He points out that this is a very predictable cut, and suspects that "the nursing home lobby is behind that." (p. 157). Into that example, Wolf also adds respite services and community transportation assistance for people with disabilities, which can prevent (or at least significantly delay) escalation to higher expense services. Wolf cautions that this should NOT mean funding transportation services that serve people who have homes to live in to go to recreational events while others remain homeless or reside in nursing homes for lack of essential transportation, NOR does it mean providing subsidies to families with means, while transportation for the poor is unavailable. Wolf also includes community integration supports for released convicts, which he says "typically cost a tiny fraction of imprisonment costs, save vast sums by reducing recidivism, but are also commonly among the first to be eliminated" (p. 157). He goes on to give examples, where "penny-wise and pound-foolish" (p. 157) strategies are employed, and concludes "curtailing expenses at one level or department of government in a way that increases the expenses of another is either psychopathic or insane", including uploading to federal government - and I would add, in our experience in Canada, downloading to municipal levels of government (p. 157) which merely shifts the onus but is still taking the taxpayer's money, and sometimes, taking more of it than before. Into the "extra-structural" supports and services area, Wolf also discusses what he calls "service multipliers" where 'middlemen' are cut out, and the impact of a dollar of support is "multiplied" by factors which include bringing in other services that are less expensive, volunteer time and effort, and some freedom to work without as many constraints, thereby getting more 'bang for the buck'. His example is of "giving small subsidies to families who will put in a lot of their own time and money to support a dependent family member, thus providing much unpaid service and keeping the person out of expensive service arrangements" (p. 158). He also supports Citizen Advocacy offices as examples of such "service multipliers".
More on this interesting article, including the final three recommendations for strategies, and my own comments and analysis based on my Ontario experience, in my next Blogs.
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